CLINICAL MEDICINE/ КЛІНІЧНА МЕДИЦИНА
ORIGINAL ARTICLE
UDC 612.143: 616.12-008.331.1
HYPERTENSION: RISK FACTORS,
TREATMENT TACTICS, JNC 8
Abanto A.E. Vasquez,
e-mail: e s t-v a s q u e z @ i.u a
Vasquez Abanto A.E.1, Arellano Vasquez S.B.2, Vasquez Abanto J.E .3
1Bogomolets National Medical University, Kyiv, Ukraine
2University of San Pedro, Academic and professional school of medical technology, Chimbote City, Peru.
3Emergency Department of Obolon district, Kyiv, Ukraine
Summary. A t th e p r im a r y le v e l o f m e d ic a l ca re , p a rtic u la rly in e m e rg e n c y m e d ic in e , h ig h ra te s o f c a lls c irc u la to ry
d is e a s e s ,
w h ic h
a re
d o m in a te d b y c a lls
f o r h y p e rte n s io n .
T hus,
h y p e rte n s io n
as
an
a s s o c ia te d
d ia g n o s is
a c c o m p a n ie s a lm o s t e v e r y c a s e s c a ll fo r c irc u la to ry d is e a s e s . Q u a n tita tiv e a n a ly s is o f c a lls s e rv ic e d m e d ic a l
e m e rg e n c y b rig a d e o f d is e a s e e n titie s le a d s to th e c o n c lu s io n th a t m a in ly s e rv e s to c a ll th e d is e a s e s o f th e
c irc u la to ry s y s te m , h y p e rte n s io n
w ith c ris e s , d is e a s e s o f th e re s p ira to ry , d ig e s tiv e a n d n e rv o u s s y s te m .
The
p e rc e n ta g e o f c irc u la to ry d is e a s e s a n d h y p e rte n s io n w ith c ris e s o n a ll s e rv ic e d c a lls h a v e (fo r th e 3 y e a r p e rio d )
s u c h in d ic a to rs : 4 0 .8 4 % a n d 2 5 .7 4 % re s p e c tiv e ly . In s tu d ie s , p u b lis h e d a s s o m e re s e a rc h e rs (D e la S ie rra A . a n d
G o n z 6 le z -S e g u ra D .) in 2011, a n d o th e r (M a rte ll-C la ro s N., G a lg o -N a fria A .) in 2 0 1 2 , w e re s tu d ie d th e r is k fa c to rs fo r
c a r d io v a s c u la r d is e a s e s , w h ic h e m p h a s iz e s th e ir c ru c ia l ro le in th e o c c u rre n c e o f c a r d io v a s c u la r e v e n ts . T im e ly
d ia g n o s is o f “h y p e rte n s io n ” is o fte n a s s o c ia te d w ith th e v ig ila n c e o f th e d o c to r - a fte r all, n o c lin ic a lly c o m p la in t m a y
be. B u t th e d o c to r’s w o rk is n o t th e e n d. A lth o u g h to d a y th e m a jo rity o f p a tie n ts p r e fe r s e lf-m e d ic a tio n , in c lu d in g
h y p e rte n s io n a n d re la tiv e ly , w o rk o n th e in d iv id u a l c h o ic e tr e a tm e n t is o f u tm o s t im p o r ta n t p a rt. A n d h e re th e
m o d e rn p h y s ic ia n is c a lle d u p o n to e x e rc is e th e ir p ro fe s s io n a l m e d ic a l s k ill a s w e a p p ro a c h th is fro m a n in te g ra tiv e
p e rs p e c tiv e .
To m a in s tre a m m e d ic a l tre a tm e n t o f h y p e rte n s io n J N C 8 h a s d e v e lo p e d n e w g u id e lin e s fo r th e
m a n a g e m e n t o f h y p e rte n s io n in a d u lts . O n th e o th e r h a n d , th e g ro u p o f m e d ic a l s c ie n tis ts a re e x p lo rin g n e w
m e th o d s , s u c h a s d e c re a s e d le v e l o f th e e n z y m e (p ro te in ) G R K 2 (G -p ro te in re c e p to r k in a s e 2), s u p p re s s io n o f th e
c a ro tid b o d y o r c a ro tid b o d y a n d re n a l s y m p a th e tic d e n e rv a tio n tha t, fro m th e s u b je c tiv e p o in t o f v ie w o f th e a u th o rs ,
d e s e rv e s p e c ia l a tte n tio n a n d h a v e a r e a l p e rs p e c tiv e f o r th e tre a tm e n t o f re s is ta n t h y p e rte n s io n .
Key words: h y p e rte n s io n , tr e a tm e n t o f h y p e rte n s io n , c a rd io v a s c u la r d is e a s e , r is k fa c to rs , c a rd io lo g y , b lo o d
p re s s u re , J N C 8.
Introduction. In everyday practice, once a diagnosis of
hypertension is installed at the patient, the doctor takes on
the challenge to adapt a particular type of treatment, starting
with the already well-known pharmacological drugs, in
accordance with its criteria and professional medical
experience. In many cases, especially at patients with chronic
and resistant hypertension, conventional methods often do
not give optimal results for the patient. Largely this is due to
a General affection and limited medical approaches (as many
professionals believe that only pharmacological products
have a real opportunity to help the patient), thus removing
the most important, namely, lifestyle and proper nutrition. In
other cases, the patient or his relatives and cares
(specifically in the elderly patients) is not very clearly follow
medical recommendations, sometimes resorting to abuse
self-treatment. It is important to note that in practice, in the
context o f “integrative” medicine, there are cases when
skillful combination o f different methods (including
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alternative, such as acupuncture, homeopathy and natu­
ropathy, osteopathy, physiotherapy and individual exercise)
are able to stabilize the condition, difficult to manage, being
able to talk about the real integration o f methods, techniques
and capabilities, although it becomes more apparent in cases
with mild or moderate hypertension [2, 11].
Quantitative analysis of calls serviced medical emergency
brigade of disease entities leads to the conclusion that mainly
serves to call the diseases of the circulatory system, hyperten­
sion with crises, diseases o f the respiratory, digestive and ner­
vous system. The percentage of circulatory diseases and hy­
pertension with crises on all serviced calls have (for the 3 year
period) such indicators: 40.84% and 25.74% respectively [1, 2].
In the report on the occasion of world health day 2013
“General overview o f hypertension in the world”, WHO is
clearly concerned about this problem that is reflected in the
40 pages o f information, facts and figures.
Purpose. To study recent publications and recommen­
dations regarding risk factors and ways to treat hyperten­
sion, based in the result of the JNC 8.
M aterials and Methods. Existing concepts and infor­
mation about hypertension are reviewed periodically by the
international medical community, in accordance with studies
and experience in daily practice. WHO in his report “General
information about hypertension in the world. World health
day 2013” examines the reasons for hypertension risk factors
(RF) related to behavior, socioeconomic factors, and also
group factors that may hide genetic constituting a secondary
character (for example, renal or endocrine disease), or perhaps
the factors associated with temporary anxiety (fear) before the
medical consultation (“white coat hypertension”).
R isk factors. The risk factor for the adoption o f the
WHO is a property or feature o f a specific person or any
impact on him, w hich increases the likelihood o f future
disease or injury. According to WHO research, significantly
increase the risk of sudden death three m ain factors:
hypertension, hypercholesterolemia and smoking. The main
RF in the occurrence of CVD (over 80%) are considered to be
unhealthy and unbalanced diet, inactivity and tobacco use.
The consequence o f poor diet and a sedentary lifestyle are
the factors for increasing the blood pressure, increasing the
level o f glucose in the blood, high amount o f fats in the
blood, overweight and obesity. All this combine a generic term
“intermediate risk factors” . There are also many underlying
causes that have a direct influence on the form ation of
chronic diseases (including hypertension) - globalization,
urbanization, aging population, and poverty and stress.
Concerning RF in a multicenter study, where were involving
6762 patients with AH, without previous cardiovascular
events (authors: De la Sierra A., Gonzôlez-Segura D.), published
in the magazine “Medicina clHnica de la Facultad de Medicina
de Barcelona” in may 2011, where the majority o f patients
positively met the criteria of high or very high cardiovascular
risk, the most often were identified factors o f dyslipidemia
(73,6%), elderly age (50,8%) and abdominal obesity (31,7%).
As for damage in target organs, anomalies o f the kidney were
observed the m ost (24,1%), left ventricular hypertrophy
(16,4%) and microalbuminuria (10,7%).
In the another study (authors: M artell-Claros N., GalgoNafria A.), published in the magazine European journal of
64
preventive cardiology in June 2012 was noted that newlydiagnosed patients among hypertensive patients (< 55
years) at the primary health care in Spain have expressed
association o f FR cardiovascular disease (CVD) and high
cardiovascular risk. In this study, among all patients with
hypertension, 5.8% didn’t have RF CVD, at 23.2% was
recorded at least 1 PHR, associated with high BP, at 32,8% 2, at 24,7% - 3, at 11.3 % - 4, and 2.3% were identified 5 RF
CVD. The most widespread RF CVD was the dyslipidemia
that occurs in 80,4% (at 37,9% with treatment), with
subsequent abdominal obesity, at 45,9% of patients with
hypertension. The prevalence o f metabolic syndrome
accounted 44.4%. Cardiovascular risk met at an average at
0.2% o f the sample with low concentration at 5%, moderate
at 26,1 %, w ith a high content at 47.3%, and very high
content at 21.4%.
Starting from the already known concept o f blood
pressure, BP (the force, which affects the blood on the walls
o f blood vessels, particularly arteries, when it is ejected by
the heart), the higher it is, the more efforts are necessary for
the heart to pump blood. Normal BP for adults is considered
to be 120 mmHg. (systolic BP) and 80 mm Hg. (diastolic BP),
high or increased, w hen the systolic BP is > 140 mmHg.PT.
and/or diastolic BP > 90 mmHg.PT.
As a result of high or increased BP, especially if it has
already switched to hypertension and is not controlled by the
doctor, negative health effects can be exacerbated by such RF,
which increase the likelihood of complications and progres­
sion of this condition: tobacco use, unhealthy diet, alcohol abu­
se, minor physical activity and the impact of continuous stress,
and so is obesity, high level of cholesterol and diabetes.
In studies, published as some researchers (De la Sierra A.
and Gonzdlez-Segura D.) in 2011, and other (Martell-Claros
N., Galgo-Nafria A.) in 2012, were studied the risk factors for
cardiovascular diseases, which emphasizes their crucial role
in the occurrence o f cardiovascular events.
At the primary level o f medical care, particularly in
emergency medicine, high rates of calls circulatory diseases,
which are dominated by calls for hypertension. Thus,
hypertension as an associated diagnosis accompanies
almost every cases call for circulatory diseases.
M ed ical tactic. In a retrospective study, recently
published (Petrak O. Journal of human hypertension, April
2015) “Combination antihypertensive therapy in clinical
practice. The analysis o f 1254 consecutive patients with
uncontrolled hypertension” (patients who received
antihypertensive therapy, at least in triple combinations)
notes that the most commonly prescribed hypotensive
(antihypertensive) funds were the renin-angiotensinblockers (96,8%), calcium channel blockers (82,5%),
diuretics (82,0%), beta-blockers (73,0%), medication of
Central action (56,0%) and urapidil (24,1%). Less were
prescribed spironolactone (22.2%), and alpha-1-blockers
(17.1 percent). Thiazide diuretics and its analogs, according
to the study, were assigned to more than 2/3 o f patients.
Furosemide was prescribed to 14.3% of patients treated with
diuretics. Inadequate combination therapy was rendered to
40,4% o f patients. Controversial double and one double
blockade of RAS occurred in 25,2 %. Wrong, according to
the author, the use o f combinations of two antihypertensive
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drugs with similar mechanism o f action was revealed in 28,1
%, being more common the combination o f the two drugs
with a Central mechanism (13,5%) [5, 12].
Petrak O. (O. Petrak) as a result o f his research believes
that: “The use o f controversial or incorrect combinations of
drugs w ith uncontrolled hypertension is common. Diuretics
often are assigned, and spironolactone remains largely
outside the General medical practice. Wrong combination of
antihypertensive drugs may contribute to uncontrolled
hypertension” [12].
R esults an d Discussions. Proceeding from the above,
hypertension releases o f basic drugs called as P-blockers
and sedatives, and hypertension resistance - inhibitors
angiotensin-converting enzyme inhibitors (ACEI), blockers
of receptors o f angiotensin (ARBS or ARA-II), calcium
channel blockers (CCB), diuretics, etc. In case of detection of
hypovolemia first place diuretics, and then all other drugs,
depending on the nature o f the lesion o f target organs, the
severity o f hypertension ejection and resistance.
For the last 15 years the group o f medications with
hypotensive effect remained almost unchanged, general
understanding o f pathophysiological mechanisms and
treatment o f hypertension remain relevant (including their
combination), with each day more enriched with new facts,
figures and techniques [10, 13].
Currently, the main therapeutic groups, which are used
for the management o f patients with hypertension, are (the
most rational and common combinations are shown by the
solid line): ACEI, ARBS (AT1 receptor blockers angiotensin
II), CCL, beta-adrenergic blockers, diuretics, renin inhibitors
(fig. 1). The primary drugs o f central action: (alpha
methyldopa, agonists o f receptors of imidazole, clonidine,
rilmenidine, guanfacine), antagonists o f central and
peripheral actions (reserpine, urapidil and indoramin,
peripheral alpha - and beta-blockers, alpha-adrenergic
blocking alpha-receptors o f the sympathetic nervous system
(SNS) usually causes blood vessels to contract, thereby
causing vasodilation with decreased blood pressure, such as
prazosin, terazosin), are used much less.
With resistant hypertension to this day remains a vital issue
periodic medical supervision of patients, not only because of
the risk of hypertensive crisis, but in seeking the best drug
combination for continuous treatment in such cases 11, 14].
And yet, the major reason is the attitude o f the patient (his
entourage, especially when hypertension in the elderly) to his
condition, to carry out medical recommendations.
In general, the process o f treatment o f the patient with
hypertension can be formulated as follows: “Treatment of
hypertension should be individually selected, and under
constant medical supervision, indefinite”.
The basis o f treatment o f hypertension has 2 main
principles:
1. To achieve a full normalization of AP, that is, its redu­
ction to a level below 140/90, and in persons of young age below 130/80. The exception may be patients with severe
disease (sometimes moderate) that respond to decreased
blood pressure by hypoperfusion of vital organs (below this
pressure the patient feels bad!). In these cases it is necessary
to reduce blood pressure to the maximum possible level.
2. To appoint the necessary long-acting drugs, as
these drugs prevent significant blood pressure fluctuations
during the day, it is easier to monitor their intake,
psychologically better accepted by the patients (there is no
feeling that a lot of drugs, so - and many diseases or heavier
than their state!, “there is a strong poisoning o f the body!”).
Review of th e guidelines JN C 8
The eighth joint national Committee (JNC 8: Eighth Report
o f the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure) has
published its new guidelines on management of hypertension
in adults, in accordance with the opinion of their authors is
easier compared to previously established JNC 7. In general,
guidelines JNC 8, after a thorough review o f evidence and
lessons learned, soften targets and thresholds HELL to begin
appropriate treatment, guided, as before, the age categories of
patients, and the presence of comorbidities (especially
diabetes and kidney diseases). The main points learned from
the work o f the expert group on the guidelines, can be
reflected in the following conclusions [8, 9]:
- To support the treatment o f people-hypertensive
-
-
-
ACEI - angiotensin-converting enzyme inhibitor, ARA - angiotensin receptor
antagonists (or ARB angiotensin receptor blocker), Ca+Jr antagonists (or CCB
calcium channel blocker).
Fig. 1. The combinations of major groups o f antihypertensive drugs
-
persons aged 60 years or more, striving to achieve a
BP o f less than 150/90 mm Hg.PT.
To support the treatment o f people-hypertensive
patients aged 30-59 years, striving to achieve DBP
less than 90 mm Hg.PT.
To maintain BP less than 140/90 mm Hg.PT. fo r
people younger than 60 years (for this group there
was insufficient evidence regarding the desired
sistolic BP) or fo r people up to 30 years (for this
group there was insufficient evidence regarding the
desired diastolic BP).
To follow the same thresholds and goals fo r adult
patients-hypertensive patients with diabetes or
chronic kidney disease (CKD), not diabetic, just the
same as fo r the general population with
hypertension younger than 60 years.
Offered fo r initial therapy in most patients with
hypertension, the angiotensin-converting enzyme
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-
-
-
-
inhibitors (ACEI), blockers o f receptors o f
angiotensin (ARBS), calcium antagonists or
calcium channel blockers (CCB), or thiazide
diuretics as a reasonable and equal alternatives,
thus rejecting the recommendation that thiazide
diuretics should act as initial therapy (in
accordance with the guidelines JNC 7).
Displayed a clear signal to physicians: treat
hypertension, from 150/90 mm Hg. in patients older
than 60 years and from 140/90 mm Hg. fo r everyone
else, and also to simplify the treatment, where the
most important thing is that patients achieved
therapeutic purposes, while closely observing them.
To support the commencement o f pharmacological
treatment with ACE inhibitors, ARBS, BPC or
thiazide diuretic in humans-hypertensive patients o f
non-African origin, including those who are
accompanied by diabetes, there is a moderate
evidence.
Recommended as primary therapy, peoplehypertensives o f African descent, including among
those who accompanied the SD, BPC or thiazide
diuretics.
To support the initial or additional antihypertensi­
ve therapy with ACE-I or ARBS in people with CKD,
-
-
-
-
with the aim o f improving kidney function, there is a
moderate evidence.
For most patients, hypertensive patients, is expected
to be shown the standard initial dose o f selected
pharmacological agents, increasing (or decreasing
sometimes) slowly and stepwise, depending on age,
response dynamics and needs o f the patient.
Optimal composition o f antihypertensive treatment
must ensure the effectiveness within 24 hours, one
daily dose, at least with saving 50% o f the maximum
effect by the end o f 24 hours.
The physician should continue to evaluate the
blood pressure at the patient-hypertensive and
adjust the scheme and mode o f treatment until you
reach the therapeutic goal. I f this goal cannot be
achieved with 2 drugs, you need to add and to mark
the third drug from the list, which the physician is
guided in his daily work.
Do not use ACEI + ARBS in the same patient is
hypertensive.
I f goal BP cannot be reached using only the abovementioned
groups
of
drugs
fo r
any
contraindications or need to use more than 3 drugs,
it is the prerogative o f the doctor, in his professional
judgment, to recommend the use o f other
Fig. 2. Recommended JNC 8 algorithm for the management o f AG
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CLINICAL MEDICINE/ КЛІНІЧНА МЕДИЦИНА
2.
Vasquez Abanto J.E., Vasquez Abanto A.E. Practice o f
Medicine o f Emergency Conditions // The newspaper "News of
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Guidelines JNC 8 offer recommendations based on
3.
The working group on the treatment o f arterial
hypertension o f the European Society o f Hypertension (ESH) and the
evidence for the management of hypertension and should
European Society o f Cardiology (ESC). Recommendations for the
address the clinical needs o f most patients [6, 7]. Like any
treatment o f hypertension. ESH/ESC 2013 Russian Journal of
other recommendation, Protocol or guidance these
Cardiology 2014, 1 (105): 7-94.
guidelines are not a substitute for clinical solutions medical
4.
Arguedas Quesada Jose Agustin. Guias basadas en la
evidencia para el manejo de la presion arterial elevada en los adultos
practitioner and must include and consider the clinical
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characteristics and circumstances o f each patient
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Declaration o f interest
14. Sarafidis P.A., Bakris G.L. Resistant hypertension: an
The authors declare that there is no conflict o f interest overview o f evaluation and treatment. J Am Coll Cardiol. 2008;
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Funding
1 5. Takashi Kanaia, Henry Krum. Un tratamiento nuevo para
This article did not receive any specific grant from any
una enfermedad antigua: tratamiento de la hipertensiyn arterial
funding agency in the public, commercial or not-for-profit resistente mediante denervaciyn simpôtica renal percutônea / / Rev
Esp Cardiol. 2013 [Available in: http://www.revespcardiol.org/es/unsector.
tratamiento-nuevo-una-enfermedad/articulo/90219244/#t0005].
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hipertensivas. En: Cordero J.A. y Hormeco RM. Eds. Manual de
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the controversial and unresolved issues” (7-8 November 2014). — Hypertension/International Society o f Hypertension and Other Major
Organizations: Introduction to a Focus Issue o f The Journal o f
Samara, 2014. — 170 p.
Clinical Hypertension The Journal o f Clinical Hypertension Vol 16.
No 4, April 2014. DOI: 10.1111/jch.12308
antihypertensive drugs or alternative / additional
methods.
№ 3 (89) • 2015 Ukrainian Scientific Medical Youth Journal / Український науково-медичний молодіжний журнал
67
CLINICAL MEDICINE/ КЛІНІЧНА МЕДИЦИНА
ГИПЕРТОНИЯ: ФАКТОРЫ РИС КА,
ЛЕЧЕБНАЯ ТА КТИКА, JNC 8
ГІПЕРТОНІЯ: ФАКТОРИ РИЗИ КУ,
ЛІКУВАЛЬНА ТА КТИ КА, JNC 8
Васкес Абанто А.Э.1, Арельяно Васкес С.Б.2,
Васкес Абанто Х.Э.3
Васкес Абанто А.Е.1, Арельяно Васкес С.Б.2,
Васкес Абанто Х.Е.3
Национальный медицинский университет
имени А.А. Богомольца, г.Киев, Украина
Университет Сан-Педро,
Академически-профессиональный
отдел медицинской технологии,
г. Чимботе, Перу
3Отделение НМП Оболонского района
(Центр первичной медико-санитарной
помощи № 2),г. Киев, Украина
Національний медичний університет
імені О.О. Богомольця, м. Київ, Україна
2Універсітет Сан-Педро,
Академічно-професійний відділ
медичної технології, м Чімботе, Перу
3Відділення НМП Оболонського району
(Центр первинної медико-санітарної
допомоги № 2), м. Київ, Україна
Резюме. На уровне первичного звена оказания меди­
цинской помощи, в частности в медицине неотложных
состояний, отмечается высокий показатель вызовов по
болезням кровообращения, среди которых преоблада­
ют вызовы по гипертонии. При этом, гипертония в каче­
стве сопутствующего диагноза сопровождает практичес­
ки каждый случаи вызова по болезням кровообращения.
Количественный анализ обслуженных вызовов бригадой
неотложной медицинской помощи по нозологическим
единицам позволяет сделать вывод, что в основном об­
служиваются вызовы по болезням органов кровообраще­
ния, гипертонической болезни с кризами, болезням орга­
нов дыхания, пищеварения и нервной системы. В
процентном соотношении болезни органов кровообра­
щения и гипертоническая болезнь с кризами относитель­
но всех обслуженных вызовов, имеют (за 3-х годичный пе­
риод) такие показатели: 40,84% и 25,74% соответственно.
Наряду с дислипидемией гипертония является серьез­
нейшим фактором развития сердечно-сосудистых забо­
леваний и ухудшения их прогноза. Своевременная по­
становка диагноза “гипертония” часто связана с
бдительностью врача - ведь клинически никаких жалоб
может и не быть. Но на этом врачебная работа не за­
канчивается. Хотя сегодня основная масса пациентов
предпочитает самолечение, в том числе и относитель­
но гипертонии, работа по выбору индивидуального л е ­
чения является первостепенно важной составляющей.
И здесь современный врач призван проявлять свое
профессиональное медицинское искусство, подходя к
этому с интегративной точки зрения. В целях актуализа­
ции медикаментозного лечения гипертонии ЛЫС 8 раз­
работал новые руководящие принципы для ведения ги­
пертензии у взрослых. С другой стороны, группы
ученых-медиков исследуют новые методы, такие, как
снижение уровня фермента (белка) ОРК2 (О-белок ре­
цепторов киназы 2), подавление каротидного тела или
каротидного гломуса и почечную симпатическую денер­
вацию, что, с субъективной точки зрения авторов, заслу­
живают особого внимания и имеют реальную перспек­
тиву для лечения резистентной АП
Ключевые слова: гипертензия, лечение гиперто­
нии, сердечно-сосудистые заболевания, факторы рис­
ка, кардиология, артериальное давление, ЛЫС 8.
68
Резюме. На рівні первинної ланки надання медич­
ної допомоги, зокрема в медицині невідкладних станів,
відзначається високий показник викликів по хворобах
кровообігу, серед яких переважають виклики по гіпер­
тонії. При цьому, гіпертонія супутнього діагнозу супро­
воджує практично кожен випадок виклику з хвороб кро­
вообігу. Кількісний аналіз обслугованих викликів
бригадою невідкладної медичної допомоги по нозологі­
чними одиницями дозволяє зробити висновок, що в ос­
новному обслуговуються виклики з хвороб органів кро­
вообігу, гіпертонічної хвороби з кризами, хвороб органів
дихання, травлення та нервової системи. У процентно­
му співвідношенні хвороби органів кровообігу і гіпертон­
ічна хвороба з кризами щодо всіх обслужених викликів,
мають (за 3-х річний період) такі показники: 40,84% та
25,74% відповідно. Своєчасна постановка діагнозу
“гіпертонія” часто пов'язана з пильністю лікаря - адже
клінічно ніяких скарг може і не бути. Але на цьому
лікарська робота не закінчується. Хоча сьогодні основ­
на маса пацієнтів воліє самолікування, в тому числі і
щодо гіпертонії, робота з вибору індивідуального ліку­
вання є першочергово важливою складовою. І тут сучас­
ний лікар покликаний виявляти своє професійне медич­
не майстерність, підходячи до цього з інтегративної
точки зору. З метою актуалізації медикаментозного ліку­
вання гіпертонії ЛІ\ІС 8 розробив нові керівні принципи
для ведення гіпертензії у дорослих. З іншого боку, групи
вчених-медиків досліджують нові методи, такі, як зни­
ження рівня ферменту (білка) 0Р К 2 (0-білок рецеп­
торів кінази 2), придушення каротидного тіла або каро­
тидного гломуса і ниркову симпатичну денервацію, що, з
суб'єктивної точки зору авторів, заслуговують особливої
уваги і мають реальну перспективу для лікування резис­
тентної АП
Ключові слова: гіпертензія, лікування гіпертонії,
серцево-судинні захворювання, фактори ризику, кардіо­
логія, артеріальний тиск, ЛКІС 8.
Ukrainian Scientific Medical Youth Journal / Український науково-медичний молодіжний журнал № 3 (89) • 2015